CT引导下经皮关节周围骨样骨瘤旋切术11例临床报告

CT-guided percutaneous removal of osteoid osteoma

目的探讨在CT引导下经皮旋切关节周围骨样骨瘤的治疗方法.方法 2003年2月至12月,共收治11例关节周围小病灶(直径6～11 mm,平均8.7 mm);其中男性7例,女性4例;年龄14～32岁,平均19.3岁.其中股骨近端6例、髋臼区4例,肱骨头内1例. 首先对整个瘤巢采用2 mm薄层扫描,选择穿过瘤巢中心的层面,以克氏针钻入,定位瘤巢中心,在套筒保护下用环钻沿导引针将整个瘤巢切除.CT扫描复查确定是否已将整个瘤巢切除,并将所取出组织送病理检查.结果其中9例取出的病变组织经病理证实为骨样骨瘤,1例为纤维组织,1例为结核.被病理证实的9例骨样骨瘤患者手术后次日症状缓解,无明显手术并发症发生.随访8～18个月(平均15.2个月),患者症状完全缓解,无1例复发.结论 CT引导下,经皮旋切关节周围骨样骨瘤的治疗方法,简便、安全、恢复快.

Objective To evaluate the methods of CT-guided percutaneous removal of osteoid osteoma. Methods From February 2003 to December 2003, there were 11 patients, at a mean age of 19. 3 years old （from 14 to 32 years old）. Seven cases were male, and 4 cases were female. Diagnosis was supported by the complete clinical and imaging file. Eleven cases with osteoid osteomas were treated with CT-guided percutaneous excision. The location involved were femoral neck （6 cases ）, acetabulum （ 4 cases）, humeral neck （ I case）. At first, CT scanning was done in the whole nidus with thin slices （2 mm thick）, and the CT scan slice passing through the center of the nidus was selected. Then the whole nidus was removed by trephine along the guidewire which was inserted into the bone up to the nidus and was protected by the trocar. Finally complete lesion resection was checked with CT. Results Nine cases had a final pathological diagnosis of osteoid osteomas. Complete pain relief was obtained in these patients after the day of operation. There were no complications, no recurrence and patients remained symptom free at follow-up of 8-18 months （ mean, 15.2 months）. Conclusion The methods of CT guided percutaneous removal of osteoid osteoma is a minimally invasive technique that represents the efficacy and safety.